Improved paediatric antimicrobial prescribing with a smartphone application: a before and after interventional study

Area of Science:

• Medical Informatics
• Paediatric Pharmacology
• Infectious Diseases

Background:

• Children consume high amounts of antimicrobials, necessitating complex prescribing decisions.
• Antimicrobial stewardship (AMS) interventions are often underutilized in pediatric medicine.
• The Script smartphone application was developed to aid antimicrobial prescribers in New Zealand.

Purpose of the Study:

• To assess the impact of the Script app on adherence to local antimicrobial prescribing guidelines.
• To evaluate the app's effectiveness in both adult and pediatric patient populations.
• To determine if the app's benefits were sustained over time.

Main Methods:

• Prospective collection and evaluation of inpatient and emergency department antimicrobial prescriptions.
• Comparison of guideline adherence at baseline, 4 months, and 1 year post-app implementation.
• Blinded grading of prescriptions as 'appropriate' or 'inappropriate' by investigators.

Main Results:

• Guideline adherence increased significantly from 69% at baseline to 83% at 4 months (p<0.0001).
• This improvement was sustained at 1 year, with 81% adherence (p<0.001).
• Sustained improvements were observed across medical, surgical, and emergency departments.

Conclusions:

• The Script app led to significant and sustained improvements in adherence to pediatric antimicrobial guidelines.
• Decision support tools like the Script app are particularly valuable in pediatrics due to complex dosing calculations.
• Implementing AMS interventions via prescribing support tools can enhance pediatric antimicrobial prescribing practices.